NW London Financial Strategy 14/15 18/19. Updated 29 April 2014

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1 North West London NW London Financial Strategy 14/15 18/19 Updated 29 April 2014 Clare Parker CFO, CWHHE Jonathan Wise CFO, BHH

2 Preamble The NWL-wide financial strategy set out in this document encompasses all eight NWL CCGs, plus NHS England, and incorporates contributions from all organisations. The strategy comprises three component parts, however these are all integral and related parts of the overall strategy, and as such the strategy is viewed as one pooled fund, under section 13V of the NHS Act 2006, which provides that NHS England and one or more CCGs may establish and maintain a pooled fund, defined as: (a) a fund which is made up of contributions by the bodies which established it; and (b) out of which payments may be made, with the agreement of those bodies, towards expenditure incurred in the discharge of any of their commissioning functions. The strategy enables all NWL CCGs to set a plan for 2014/15 in accordance with its statutory financial duty to ensure that its expenditure does not exceed the amount allocated. The strategy is consistent with the NHS England guidance Everyone Counts: Planning for Patients 2014/15 to 2018/19, which specifically anticipates that CCGs will work together to ensure that strategies align. It also recognised that CCGs working together enables the pooling of resources. All aspects of the NWL financial strategy are subject to NHS England agreement as part of their review and sign-off of 14/15 Operating Plans for all CCGs, and as part of this, ensuring adherence to statutory and other requirements on CCGs. It is anticipated that the transfer of resources between CCGs will be enacted by NHS England under section 223G(4) of the NHS Act 2006, whereby NHS England can make a new allotment, increasing or decreasing an allotment previously made. 2

3 14/15 15/16 Allocations Target allocations were published for all CCGs on the 20 th December The table below shows the opening position and the resulting closing 2015/16 distance from target, following two years differential allocation growth. 13/14 14/15 14/15 15/16 15/16 15/16 Opening CCG Distance Allocation target Distance Distance Programme from target per head allocation from target from target Budget value per head Allocation % % m m NHS Brent CCG % 6.28% NHS Harrow CCG % -8.80% 243 (21) NHS Hillingdon CCG % -7.73% 303 (23) NHS Central London CCG % 26.33% NHS Ealing CCG % -5.14% 439 (23) NHS Hammersmith & Fulham CCG % 12.79% NHS Hounslow CCG % % 298 (33) NHS West London CCG % 33.49% Indicative NWL Total = 5.44% 2, The table below shows the distribution of funding growth between CCGs in 2014/15 and 2015/16. 13/14 baseline 14/15 uplift uplift 15/16 uplift uplift 000s 000s 000s % 000s 000s % NHS Brent CCG 366, ,262 7, % 380,624 6, % NHS Harrow CCG 224, ,162 9, % 243,174 9, % NHS Hillingdon CCG 278, ,919 12, % 302,518 11, % NHS Central London CCG 243, ,999 5, % 253,232 4, % NHS Ealing CCG 409, ,700 15, % 439,339 14, % NHS Hammersmith & Fulham CCG 239, ,607 5, % 248,765 4, % NHS Hounslow CCG 274, ,628 12, % 298,008 11, % NHS West London CCG 328, ,133 7, % 340,830 5, % 3

4 Objectives and Business Rationale for NWL-wide Financial Strategy The Collaboration Board were clear that all aspects of the financial strategy should be explicit enablers of the implementation of the NWL 5 year strategy (i.e. Shaping a healthier future). The following specific objectives are therefore proposed to embody the above: - all CCGs need to be in a position to be able to implement their Out-of-Hospital strategies in a consistent manner and timeframe. - SaHF programme management needs to be adequately resourced. - significant investment in primary care (networks, estates etc.) is required to underpin OOH strategies across NWL. - transition support for acute providers needs to be explicitly tied to SaHF implementation. - the investment in NWL-wide S&T programmes (Whole Systems, 7 Day Working, Mental Health Transformation etc.) needed to support SaHF implementation (separate CB paper sets out how the portfolio of projects support the delivery of the SaHF vision). The business rationale for a NWL-wide financial strategy are: - SaHF is a NWL-wide programme and the probability of successful implementation would be significantly enhanced by a NWL-wide financial strategy. - Individual CCGs are in radically different financial positions with surpluses/deficits which are predominantly the result of inherited PCT positions, and surpluses/deficits correlate with under/over funding positions. - If the wide disparity in CCG financial positions is not addressed through a NWL-wide financial strategy, SaHF implementation as a whole could be compromised. - A NWL-wide financial strategy provides resilience to all CCGs in the light of potential future funding changes, and also in facing provider issues together. 4

5 Proposed NWL-wide financial Strategy Based on the above, a financial strategy is proposed comprising three component parts: A) Pooling of CCG and NHS England non-recurrent headroom to support non-recurrent SaHF costs. B) Utilising CCG carry forward surpluses to enable Out-of-Hospital implementation across NWL, by placing all CCGs on a common footing. C) Creation of SaHF Out-of-Hospital recurrent investment fund to support investment in primary care and community services. The following tables reflect proposed approaches and the impact on each CCG in 14/15 of the proposed strategy, which comprises all three parts of an integrated whole. 5

6 Proposed Strategy Part A NHSE planning guidance for 2014/15 includes a requirement that: Commissioning organisations are required to set aside some of their funding for non-recurrent expenditure. Recognising the need to accelerate efficiencies in 2014/15 both to prepare for the challenges of 15/16 and to create funding for service change, we have increased the level of non-recurrent expenditure in 14/15 to 2.5%. For 2014/15, contributions at 2.5% would be as follows: m Brent 9.4 Ealing 10.6 Central 6.2 H&F 6.1 Wes 8.4 NHSE 16.3 Total 57.0 It is proposed that 2.5% be continued to be used as a planning assumption for 15/16 with contributions in 16/17 onwards to be confirmed nearer the time. It is proposed that Part A of the fund be used to support: - SaHF programme and implementation costs - Enhanced integration programme (e.g. Whole Systems) - Other NWL-wide Strategy & Transformation programmes, including PM challenge fund and mental health transformation - Acute provider transition, as per the criteria agreed by the SaHF Programme Board The distribution of funding across the above to be agreed annually, including the need to prioritise funding across programmes, or if necessary seek additional contributions. 6

7 Proposed Strategy Part B NHSE expectation/requirement is for CCGs to operate with a 1% surplus. In 13/14, four CCGs in NWL have a much larger surplus; two have deficits. NHSE planning guidance states that: Surpluses and deficits accumulated at 31/03/14 and subsequent years will be carried forward in the following financial years. In respect of Harrow and Hillingdon, the impact of carried forward13/14 (and projected 14/15) deficits, would be both to render impossible the implementation of SaHF Out-of-Hospital strategies, and also to impact adversely on outcomes. Furthermore, the deficits are correlated with underfunding indicated by the National Capitation Formula. It is therefore proposed that 40% of the carry forward surpluses in the 4 CCGs with large surpluses be pooled, under Part B, to be used to ensure that SaHF OOH strategies are implementable across all 8 CCGs: Surplus CCGs Total ( m) % m Brent Central H&F West Total In addition to the above, the Collaboration Board in March agreed additional support of 5m for Harrow CCG ( 2m from Brent CCG and 3m for CWHHE, split to be agreed). This enabled Harrow CCG to set a balanced budget for 2014/15 in line with the principles of the strategy. 7

8 Proposed Strategy Part C In order to support the implementation of CCG Out-of-Hospital strategies in a consistent manner and timeframe, Part C of the fund is to focus on SaHF OOH recurrent (revenue) investment. Out of Hospital strategies also require capital investment, which is not covered here. It is proposed that Part C contributions be calculated as follows: a) A 1% contribution by all CCGs ( 23.6m) b) A further 23.6m contribution from the five CCGs with 13/14 underlying recurrent surpluses, in proportion to 13/14 forecast exit run rates c) A contribution (TBC) from NHSE in respect of primary care growth (1) This would create an investment pool of 47.2m (excl. NHSE), which it is proposed to allocate as follows: a) Return 1% to the three CCGs not in recurrent balance ( 7.7m) b) The remaining 39.5m in proportion to capitation target The resultant net contributions to Part C are summarised below, with four CCGs being net contributors, and four being net recipients. Sources ( m) Application ( m) Net ( m) Brent (6.2) Harrow Hillingdon Ealing Hounslow Central (2.2) H&F (2.5) West (6.4) Total (excl. NHSE) Note (1) London has received primary care growth of 1.6% in 14/15. The NWL growth, if utilised as part of the above, will enable NHSE (L) to discharge their responsibility to account to local stakeholders for how the patterns of deprivation reflected in their allocation have been reflected in their allocation choices. NHSE (1) TBC - Total TBC - NB. Totals may not add due to rounding 8

9 Affordability and Future Proofing The principles governing the 5 year strategy are proposed to be: - Contributions to the financial strategy each year should be determined based on affordability, with the CCGs in the strongest financial position contributing the most. When assessing the financial position of a CCG both the underlying surplus/deficit of the CCG and its distance from target should be considered. - All CCGs have equal right to draw from, and responsibility to contribute to, the financial strategy, should financial positions of individual CCGs change. - In acknowledgement that NWL as a whole is 136m above the capitation funding level, all CCGs commit to ensuring that funds are invested in a way that represents value for money and reduces recurrent costs over time while maintaining high quality services. - All CCGs commit to spending the financial strategy funding to achieve the aims for which the budget is set, and will hold each other to account for delivering this. In the current financial scenario, Brent, Central, West and H&F will be significant net contributors in 14/15. In future years, if the allocation model is implemented in full, then other CCGs may well be in this position, and all 8 CCGs need to agree this strategy in acknowledgement of this. 9

10 Governance Arrangements In line with existing governance arrangements, each CCG as a separate statutory organisation, as well as NHS England, will need to approve the NWL-wide financial strategy (based on a recommendation from the Collaboration Board). The Collaboration Board does not have financial decision-making authority other than that delegated to it by the existing CCG Governing Bodies. Given the complexity of managing and implementing a multiyear financial strategy across 8 statutory organisations, consideration needs to be given whether these existing mechanisms are sufficient and a formal collaborative finance committee to oversee the strategy has been agreed. For pan-nwl budgets created from the fund, day-to-day budget management will be delegated to the Director of Strategy and Transformation across the 8 CCGs, with monthly reports as now to the Collaboration Board. It is proposed that Central London CCG continues to act as the host for shared costs and procurement of external resources, where appropriate. As in 13/14, where resources are allocated from the Strategy to CCGs, each CCG would be accountable for budget management and ensuring that the objectives underpinning the allocation are delivered. All transitional funding allocations to providers will be subject to the review process agreed by the SaHF Programme Board; and will be agreed with the SaHF Programme Board and the Collaboration Board. 10

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